More than 1.9 million people in the U.S. suffer from opioid abuse, reports the National Institute on Drug Abuse. Sadly, many of those who abuse prescription opioids lose their lives due to overdose. According to the Centers for Disease Control and Prevention (CDC), more than 165,000 people died of prescription opioid overdose during the most recent reporting period, which ranged from 1999 to 2014. However, attitudes toward the best way to combat the epidemic are changing.
The Problems With Current Medication Treatments for Opioid Abuse
Those suffering from opioid abuse often rely on medications to reduce the desire for opioids. This form of treatment seeks to encourage sobriety by allowing a person to safely lower his or her dependence on the drug to function. Yet, the daily struggles with remembering to take these medications increases the risk of relapse, explains CBS News. For some, a missed dose could lead to intense, overwhelming urges to abuse opioids.
Meanwhile, oral medications used to treat opioids can be sold illegally on the street, and injections containing buprenorphine, a medication used to treat opioid withdrawal and dependence, are still in infancy. Even approved injections can have extremely high costs, which may not be covered under insurance plans if a suitable oral injection is available. However, the Food and Drug Administration (FDA) has recently approved a buprenorphine implant to treat opioid addiction.
How Does a Buprenorphine Implant Work?
The implant contains 80 milligrams of buprenorphine in a 26 mm by 2.5 mm diameter rod. The implant is placed into the upper arm, similar to some forms of birth control, and it releases a sustained dose of buprenorphine over six months. Although the amount of buprenorphine in the implant seems minimal, fewer actual milligrams are required to bring the serum plasma level of buprenorphine to sustainable levels.
Depending on the previous medication administration of oral opioid antagonists, multiple buprenorphine rods may be implanted into the arm. But, the FDA’s final ruling on the implant clearly provides direction for the maximum daily dose of the implant to be the equivalent of eight milligrams.
Since the implant only lasts for six months, it must be removed or replaced upon the completion of the period. Unfortunately, each insertion, removal or replacement of the implant does increase the risk of complications, including bacterial infection, rejection or pain at the implant site. Furthermore, additional study is needed to determine the effectivity of the implant in those with other co-occurring major medical problems, such as diabetes or heart disease.
What Is the Benefit of the Implant?
The buprenorphine implant is greatly beneficial to those who struggle with the daily decision to refrain from or abuse opioids. For those taking injections or oral medications, every day is another opportunity to relapse. While relapse is still possible with the injection, the person with the implant does not have to physically do anything to “take” the medication. Ultimately, it enhances quality of life.
Buprenorphine does not just inhibit opioid withdrawal symptoms. It is also known as an opioid antagonist. When a person abuses opioids, including prescription opioids and heroin, molecules in the opioid bind to dopamine receptors in the brain, producing a euphoric effect that blocks pain signals. A dopamine antagonist functions by effectively blocking the receptor sites without activating a dopamine release. As a result, taking an opioid while taking buprenorphine will not produce euphoric symptoms.
Who Is a Candidate for the Buprenorphine Implant?
The implant is a fantastic opportunity and innovation in the treatment of opioid addiction. However, the implant is not a one-size-fits-all treatment. Those who are currently being treated with a “low or moderate dose of oral buprenorphine” are ideal candidates for the implant, explains the Wall Street Journal. Furthermore, if a person must take additional oral medications to manage opioid addiction, the key benefit of the implant is lost.
Those who are seeking help for opioid addiction for the first time may not benefit from the implant. The few weeks following detoxification are the times when relapse is most likely. As a result, treatment services providers should help those who have recently completed detoxification reach the eight-milligram daily dose of buprenorphine before exploring implant options.
The success of the implant in maintaining sobriety is also directly related to utilization of support systems for overcoming addiction.
For example, Braeburn Pharmaceuticals, one of the manufacturing partners in creating the implant, expect those who receive the implant to continue on with counseling sessions or additional therapeutic activities. In other words, developing coping skills, continuing in cognitive behavioral therapy sessions or attending interdimensional family therapy sessions are essential to the success of recovery with the implant.
What Does the Implant Mean to You?
The development of the implant means you have additional treatment options to explore when working with clients who suffer from opioid addiction. As a social worker, you may point out how the implant could eliminate the “social embarrassment” for those who must refill buprenorphine medications at a pharmacy. Obviously, HIPAA laws prevent the disclosure of information, but for some, the idea of just going to a pharmacy to refill medications to treat opioid addiction may be embarrassing.
You also have the chance to spread awareness of the importance of getting help for addiction with announcements of the new implant’s availability to those currently in recovery. The implant only became available for use at the end of June, so you may need to check with local clinicians to determine if the implant is available in your area.
Although the FDA has cleared the implant for use, its effectiveness is still under debate. As a result, Braeburn has created a policy to refund money to insurers if the implant fails in helping your clients avoid relapse. Moreover, Braeburn is working to offer assistance through the Braeburn Access Program™ for those who have to buy the implant on their own, explains NPR.org.
The buprenorphine implant represents a significant opportunity to help those with addiction to opioids achieve lasting sobriety. By understanding how the implant is used, who it is most beneficial to and how to help those with addiction obtain the implant, you can improve the overall health of the community you serve.